I need some collagen over here � the vagina monologues

A second glance at this study sheds some light on the real cause of pelvic organ prolapse in young women

By Tony Craig

A study that went largely unnoticed when it was published in December is beginning to attract attention since it may explain previously baffling cases of pelvic organ prolapse (POP) in young, healthy women. According to the small but potentially important study published in the American Journal of Obstetrics and Gynecology, POP and the urinary incontinence it so often causes, may be symptoms of an unknown connective tissue disorder.

POP results when the uterus and/or the vagina drop down from its normal position because the pelvic floor muscles become weak or damaged. "We often blame prolapse or incontinence on childbirth, ageing or chronic straining," said study author Dr Oz Harmanli, assistant professor of obstetrics and gynecology at Temple University School of Medicine in Pennsylvania. "But such is not the experience for all women. Some older women enjoy strong pelvic support in their 80s, while some women in their 30s suffer from weak pelvic floors, regardless of other factors. Our study examined whether the connective tissue, specifically collagen, influenced risk of pelvic floor disorders."

Collagen is of course essential in holding tissue together. Previous studies have found low levels of collagen in prolapsed pelvic supporting tissue, but it wasn't clear whether the shortage of collagen was a cause or a result of prolapse. This study looked at tissue from the cervix, which isn't a support structure and therefore not affected by prolapse.

The researchers examined cervical tissue from 14 women who had POP with and without stress urinary incontinence and 17 controls without these conditions. The specimens were obtained after surgery for benign gynecologic conditions. Average cervical collagen content in the women who had suffered prolapse was only 8.1%, compared to 12.35% in the women with healthy pelvic floors. Yet the groups were closely matched in terms of age, parity, body mass index and tobacco use.

"We found that women with prolapse and incontinence had decreased amounts of collagen in the cervix, regardless of all other factors. This supports the theory that there's an intrinsic factor that can contribute to these problems, and everything else, such as childbirth and obesity, is additive," said Dr Harmanli. What that intrinsic factor may be remains a mystery. The researchers plan to try to replicate their findings in a larger group of women.